INTRODUCTION-This study was undertaken to evaluate the existence, accessibility, surgical definition of avascular holy planes and their applicability in performing a safe laparoscopic cholecystectomy (LC), by exploring them by cold dissection alone keeping the energized dissection (ED) as a rescue hemostatic aid.

METHODS AND PROCEDURES -A prospective (June 2005- June 2012) case series of consecutive unselected consenting candidates for LC performed on index hospitalization without any exclusion (except unfitness for general anesthesia) at the apex tertiary level Institute that pioneered laparoscopic surgery in North India. Standard 4 port LC with a standard perioperative protocol was followed. Cystic duct/artery were endoclipped. Dissection was done in accessible avascular planes (without ED) between the gallbladder (GB) and adjoining structures / adhesions. Study Points-

All patients could take care of themselves the day after surgery and resume normal activity within 5 days of surgery . There was no biliary leak / re-hospitalization / mortality. No adverse event was seen during the 3 month follow up.

CONCLUSIONCystic artery is the only blood supply to the GB, once clipped there is always a avascular holy plane for surgical dissection for safe laparoscopic cholecystectomy without the need for ED. The outcomes seem to be encouraging (in absence of ED), which need to studied further in better designed studies like RCT if ethically acceptable and permissible.